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Best private insurance?

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Ulcerative Colitis
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Posted 9/2/2021 5:25 AM (GMT 0)
Hi all, I have pancolitis and expect to transition from Imuran to biologics in the next few months - years of stepping up seem to have lost effectiveness, in fact I've never been in true endoscopic remission. It's time to bring in the big guns.

Anyway, I'm also looking to retire early in the next couple years (I'll be in my early-mid fifties.) This means I will be subject to the ridiculous expense of private health insurance in the USA.

When I examine various plans, I see many that don't appear to cover Humira or Remicade, for example.

Can you give me any recommendations for private insurance that covers the more common Biologics?

Thanks much.
Posted 9/2/2021 12:32 PM (GMT 0)
I think all ACA approved plans have to cover one of each type of medication - they might force you to take a generic version of Remicade.

HMO type of plans offer the best types coverages. I’m making a generalization. You could hire an insurance agent to find a plan that is right for you.
Posted 9/2/2021 12:42 PM (GMT 0)
Most formularies don't list the biologics because they are specialty meds. The infusion meds are usually covered under the major medical/hospital part of the plans instead of the drug plans. Most should be covered the same as chemotherapy drugs are covered. Could you find an insurance advocate who can help you wade through the plans? I think the Blue Cross plans might cover the most.

I have a love/hate relationship with insurance. I hate that it's so difficult navigate and that we are at the mercy of whatever they decide they will cover (which can change year to year) but I love that it allows me to afford care that I would not be able to without it.
Posted 9/2/2021 5:23 PM (GMT 0)
I have Cigna. And in my case I have to order my biologic through their speciality mail order group called Accredo.

The coverage is great.
And once you get going on a drug with them it’s pretty much hassle free.

But when you start a new drug or your prescription needs a refill. It becomes a phone call cable company type nightmare for both you and the person that deals with insurance companies at your doctors office.

I mean days and days of multiple phone calls to get things right.
Posted 9/2/2021 6:00 PM (GMT 0)
Thanks, guys, for the info. I've actually lived out of the US for the last 6 years, with company-provided health insurance.

Are there actually insurance agents/advocates that will help a person shop smartly for private health insurance?
Posted 9/2/2021 6:10 PM (GMT 0)
Not sure when you will be returning stateside but to answer your question, yes there are insurance brokers that can help you find coverage that fits your needs the best. They do not charge you, they will be paid a fee by whatever company you go with. It's premature at this point to be looking at coverage, a lot can & will change when you are ready to go private.
Posted 9/2/2021 6:26 PM (GMT 0)
It probably is better to wait until you know which biologic you’ll be going on. Each plan is different in the drug it covers and once you know you can pick the plan that will cover your needs. Be sure to plan for a BIG outlay in your budget tho. And it gets worse the older you get.
Posted 9/2/2021 7:15 PM (GMT 0)
Yeah, I wouldn't start shopping until I was in my last year here, and that's at least two years down the road, at which point I hope to have successfully been on either Remicade or Humira for some time (those are the two biologics preferred here in the Middle East). It's good to know there are agents who can help me make a wise choice in coverage. Thanks, everyone, for your insights.
Posted 9/3/2021 2:39 AM (GMT 0)
You can also use health navigators (provided by the government) if you are going through the healthcare exchanges
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